Seguridad de la nutrición enteral intermitente frente a la continua en los pacientes críticos. Ensayo clínico aleatorizado

IF 1.1 Q3 NURSING

Enfermeria Intensiva Pub Date : 2025-06-27 DOI:10.1016/j.enfi.2025.500561

María Dolores Saiz-Vinuesa RN, MSc, PhD candidate , Eloina Rodriguez-Moreno RN , Francisca Calero-Yánez RN, MSc, PhD candidate , Ana María Piqueras-Carrión TCAE , Carmen Carrilero-López RN , Isabel Murcia-Sáez MD, PhD , María Pilar Córcoles-Jimenez RN, MSc, PhD , Milagros Molina-Alarcón Psy, PhD

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引用次数: 0

Abstract

Introduction

Enteral nutrition (EN) is a common nutritional support in intensive care units (ICU). The administration method can be continuous (CEN)or intermittent (IEN), but there are controversies and a lack of evidence on which method is more effective in achieving good nutritional status while minimizing complications.

Objectives

To evaluate the safety (no increase in complications) IEN versus CEN during administration of EN with a gastric feeding tube (GFT) in ICU patients.

Methods

Randomized, open clinical trial. Registered in Clinical Trials. Population: Adults >18 years admitted to ICU, with GFT, indication of EN, signed consent. Exclusion: insulin-dependent diabetic. Intervention: Control (CEN): continuous administration via infusion pump; Experimental (IEN): the total amount divided into 4 doses, administered q 6 h via infusion pump, for 1 hour each dose. Outcome variables: complications (gastrointestinal, respiratory, metabolic), achievement of caloric goal (CG) Others: demographic data, nutritional status, severity (APACHE), EN type, mechanical ventilation (MV), duration of EN, causes of interruption. Statistical analysis: SPSS. Intention-to-treat analysis. Measures of central tendency and dispersión (standard deviation or interquartile range: IQR), absolute and relative frequencies. Bivariate analysis: Chi-cuadrado, t-Student and U-Mann-Whitney.Ethical aspects: CEIm approval.

Results

Forty patients (18 CEN/22 IEN), 70% (28) men, age 62.65 DE: 13.27 years (95% CI: 58.40-66.90), BMI: 27.93 (IQR: 4.6), APACHE II: 18.85 DE: 5.83 (95% CI: 16.98-20.72), MV: 11.5 days (IQR: 13). 17.5% (7) diabetic. The CEN and IEN groups were homogeneous for all variables except APACHE (CEN 21.22 vs. IEN 16.91; P=.018). CG was achieved by 82.5% (33) (88.9 CEN vs.77.3% IEN; P=.33), time to achieve it (36 hours CEN vs. 34 h IEN; P=.28). Complications: vomiting: 20% (8) patients (4 per group; P=.75). Diarrhea: (16.7% CEN vs. 22.7% IEN; P=.63). Bronchial aspiration and GRV > 500 cc 1 case in IEN. Median interruptions (2.5 [IQR: 2] CEN vs. 1 [IQR: 2] IEN; P=.005).

Discussion

The results are similar to other studies. CG was achieved in a high percentage, with no differences between groups. The use of INE shows feweer interruptions, which may lead to better compliance with caloric guidelines without increasing complications, maintaining physiological guidelines.

Conclusion

IEN in ICU patients shows no differences in terms of complications, compared to CEN, nor less effectiveness in achieving the CG. A larger sample is needed to identify the advantages and complications of each method.

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危重病人间歇性肠内营养与连续营养的安全性。随机临床试验

肠内营养（EN）是重症监护病房（ICU）常见的营养支持。给药方法可以是连续给药（CEN）或间歇给药（IEN），但关于哪种给药方法更有效地达到良好的营养状态，同时最大限度地减少并发症，存在争议和缺乏证据。目的评价EN与CEN在ICU患者胃饲管（GFT）下的安全性（无并发症增加）。方法随机、开放临床试验。临床试验注册。人群：18岁成人，ICU， GFT， EN指征，已签署同意。排除：胰岛素依赖型糖尿病。干预：控制（CEN）：通过输液泵持续给药；实验（IEN）：总剂量分为4剂，每6 h通过泵给药，每1 h给药。结局变量：并发症（胃肠道、呼吸、代谢）、热量目标（CG）的实现其他：人口统计数据、营养状况、严重程度（APACHE）、EN类型、机械通气（MV）、EN持续时间、中断原因。统计分析：SPSS。意向处理分析。集中趋势和dispersión（标准差或四分位数间距：IQR）、绝对频率和相对频率的度量。双变量分析：Chi-cuadrado， t-Student和U-Mann-Whitney。伦理方面：CEIm批准。结果40例患者（18例CEN/22例IEN），男性占70%（28例），年龄62.65岁，DE: 13.27岁（95% CI: 58.40-66.90）， BMI: 27.93 (IQR: 4.6), APACHE II: 18.85 DE: 5.83 (95% CI: 16.98-20.72), MV: 11.5天（IQR: 13）。17.5%（7人）患有糖尿病。除APACHE外，CEN组和IEN组在所有变量上均均匀(CEN 21.22 vs. IEN 16.91；P = .018)。CG达到82.5%（33例）(CEN为88.9，IEN为77.3%；P= 0.33)，实现时间(36小时CEN vs. 34小时IEN；P =陈霞)。并发症：呕吐：20%(8)例（每组4例）；P =炮)。腹泻：CEN占16.7%，IEN占22.7%；P =点)。支气管吸入与GRV >；500cc 1例IEN。中位中断(2.5 [IQR: 2] CEN vs. 1 [IQR: 2] IEN；P = .005)。讨论结果与其他研究相似。CG达到了很高的百分比，组间无差异。INE的使用显示更少的中断，这可能导致更好地遵守热量指南，而不会增加并发症，维持生理指南。结论与CEN相比，ien在ICU患者的并发症方面没有差异，在实现CG方面的效果也不差。需要更大的样本来确定每种方法的优点和复杂性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Enfermeria Intensiva NURSING-

CiteScore

2.50

自引率

23.10%

发文量

期刊介绍： Enfermería Intensiva es el medio de comunicación por antonomasia para todos los profesionales de enfermería españoles que desarrollan su actividad profesional en las unidades de cuidados intensivos o en cualquier otro lugar donde se atiende al paciente crítico. Enfermería Intensiva publica cuatro números al año, cuyos temas son específicos para la enfermería de cuidados intensivos. Es la única publicación en español con carácter nacional y está indexada en prestigiosas bases de datos como International Nursing Index, MEDLINE, Índice de Enfermería, Cuiden, Índice Médico Español, Toxline, etc.